FLU

The underestimated threat

.

Influenza Virus Types• Type A

– humans and other animals– all age groups– moderate to severe illness

• Type B – milder epidemics– humans only– primarily affects children

• Type C - uncommon strain, no epidemic

Increased Risk

• Age 65 and older

• Any age with chronic medical conditions

• Pregnant women

• Children 6-23 months

How the Flu Spreads

Spread of Flu

• Droplet Spread– from a person’s cough or sneeze– person touches respiratory droplets on another

person or object and then touches their own mouth or nose

• Incubation period = 1-4 days

Symptoms

• Adults- shed virus 1 day before developing symptoms to 7 days after getting sick

• Young children- can shed virus for longer than 7 days

Hospitalization from Influenza

• Highest rate among young children and persons >65 yrs

114,000 hospitalizations/yr with 57% occurring in ages < 65 yrs

• Highest # caused by type A (H3N2) viruses

Death rates from influenza-associated pulmonary and circulation

deaths/100,000 persons

• 0-44 yr: 0.4 - 0.6• 50-64yr: 7.5 65yrs: 98.3• Reasons:

– more older people has inc.– Influenza A associated with higher mortality– Influenza A predominates in 90% of seasons from

1990-99 compared w/57% of seasons 1976-90

Preventing the Flu

• Good Health Habits

• Vaccination

• Antiviral Medications

Good Health Habits

• Avoid close contact• Stay home when you

are sick• Cover your mouth• Clean your hand• Avoid touching your

eyes, nose or mouth• Get plenty of rest• Drink plenty of liquids

• The simplest way to avoid the flu is to avoid crowds. Can’t keep you

kids cooped up? Frequent hand

washing is the next best thing

Vaccination

Vaccine Production Capacities

• 65-70% of global vaccine production located in Europe (5 companies)– 50% of that production is exported outside of Europe

1

14

22

76

120

148

164

168

181

186

204

218

289

328

0 50 100 150 200 250 300 350

Egypt

UAE

Mexico

Brazil

Sweden

Greece

Japan

France

Germany

UK

Australia

Korea

US

Canada

Doses vaccine/1000 population

Use of influenza vaccine in 14 countries. (Vaccine 2003

(16) :1780-1785)

Live virus

LAIV Inactivated vaccine WV

Subunit vaccine SU

Split vaccine SPL

rosettes

Adjuvanted vaccine

Virosomalvaccine

Vaccination

• Best way to prevent flu

• Selection of virus for manufactured vaccine made in Feb and April each year

• Get vaccinated each fall

• People at high risk should get vaccinated

• 2 kinds of vaccines– inactivated– live attenuates (LAIV) (for ages 5 - 49)

Who Should Not Get Vaccine

• Have severe allergy to hen’s eggs (anaphylactic allergic rxn)

• People who previously developed Guillian-Barre syndrome (GBS) w/in 6 weeks after getting a flu shot

Influenza Vaccination Strategy

• Yearly vaccination of high risk persons is the most effective means of reducing the effect of influenza

– persons with increased risk

– close contacts and care-givers of persons with increased risk

Persons at High Risk

• All persons 50 years of age or older

• Persons >6 months of age with chronic illness

• Residents of long-term care facilities

• Pregnant women (2nd and 3rd trimesters)

• Children 6 months to 18 years receiving chronic aspirin therapy

• Children 6-23 months of age

Chronic Medical Conditions

• Pulmonary (e.g. COPD, asthma)

• Cardiovascular (e.g. CHF)

• Metabolic (e.g. diabetes)

• Renal (e.g. chronic renal failure)

• Hemoglobinopathies (e.g. sickle cell)

• Immunosuppression (e.g. HIV)

HIV Infection

• Persons with HIV at higher risk for complications of influenza

• Vaccine induces protective antibody titers in many HIV-infected persons

• Transient increase in HIV replication reported

• Vaccine will benefit many HIV-infected persons

Pregnancy and Inactivated Influenza Vaccine

• Risk of hospitalization 4 times higher than nonpregnant women

• Risk of complications comparable to nonpregnant women with high-risk medical conditions

• Vaccination recommended if pregnant during influenza season

Contacts of High-Risk Persons

• Household members and caregivers of high-risk persons (including children 0-23 months)

• Health care providers, including home care

• Employees of long-term care facilities

Other Groups

• Providers of essential community services

• Foreign travelers

• Students

• Anyone who wishes to reduce the likelihood of becoming ill from influenza

Composition of the 2003-2004 Influenza Vaccine

• A/Moscow/10/99 (H3N2)

(A/Panama/2007/99)

• A/New Caledonia/20/99 (H1N1)

• B/Hong Kong/330/2001

Composition of the 2004-2005 Influenza Vaccine*

• A/Fujian/411/2002 (H3N2)

(A/Wyoming/3/2003)

• A/New Caledonia/20/99 (H1N1)

• B/Shanghai/361/2002

(B/Jilin/20/2003 or B/Jiangsu/10/2003)

*strains in (parenthesis) are antigenically identical to the selected strains and may be used in the vaccines

Live Attentuated Intranasal Influenza (LAIV)

• Contains weakened live influenza vs killed viruses

• Administered by nasal spray

• Contains 3 different live (but weakened) viruses, which stimulate body to make antibodies

Dosage-LAIV

• 0.5 mL of vaccine: 0.25 mL for each nostril

• Children aged 5-8 previously unvaccinated: receive 2 doses separated by 6-10 weeks

• Children aged 5-8 previously vaccinated: receive 1 dose (do not require a 2nd dose)

• Persons aged 9-49: receive 1 dose

Efficacy & Effectiveness of LAIV-adults

• 85% overall efficiency

• Fewer days of illness

• 15-42% fewer health care provider visits

• 43-47% less use of antibiotics

LIAV Side Effects

• Children– runny nose

– headache

– vomiting

– muscle aches

– fever

• Adults– runny nose

– headache

– sore throat

– cough

– fever

Inactivated Influenza Vaccine

• Contains two type A and one type B

• Made from purified, egg grown viruses that have been inactivated or killed

• Antibiotics can be added to prevent bacterial contamination

• Vaccinated people develop high postvaccination hemagglutination inhibition antibody titers

Effectiveness of Inactivated Vaccine- Children

• 77% - 91% effective against influenza respiratory illness

Effectiveness of Inactivated Vaccine-Adults

• Aged < 65 yrs old:– 70-90% efficient work absenteeism, health-care resources

• Aged > 65 yrs old:– 50-60% effective in preventing hospitalization

for pneumonia and influenza– 80% effective in preventing death

Side Effects to Inactivated Vaccine

• Soreness at vaccination site• Fever, malaise, myalgia• Guillain Barre Syndrome: 1 additional case

per 1 million people– Body's immune system attacks part of the

nervous system and results in weakness or tingling sensations in the legs that can spread to the arms and upper body.

– Can result in paralysis

Inactivated v. Live Vaccines

• Similarities– contain one influenza

A (H3N2) virus, one A (H1N1) virus, and one B virus

– vaccines grown in eggs

– administered annually

• Differences– Inactivated has killed

virus, LAIV contains attentuated viruses

– Cost: LAIV more expensive

– Administration• LAIV: intranasally

• dead: intermuscularly

پيشگيري و كنترل آنفلوانزاي بيمارستانيطغيان هاي بيمارستاني ناگهاني و انفجاري هستند•سه منبع مهم انتشار عفونت در بيمارستان شامل •

بيمار، كاركنان و مالقات كنندگان ميباشدتشخيص بموقع طغيان هاي بيمارستاني اهميت •

زيادي داردضرر اقتصادي–كاهش نيروي انساني ارائه دهنده خدمت–افت كيفيت خدمات ارائه شده –

كاركنان تبديل به مخزن بالقوه براي انتقال به •بيماران و اعضاء خانواده خود مي شوند

كاركنان غير ايمن نسبت به ساير اقشار در معرض • خطر بيشتري هستند

پيشگيري و كنترل آنفلوانزاي بيمارستانياحتمال انتقال از طريق افشانه هاي آلوده صورت ميگيرد لذا •

الزم است به محل بستري بيماران مشكوك توجه گرددبيماران با عالئم تنفسي تا قبل از روشن شدن وضعيت در •

ميان ساير بيماران بستري نشونداز تردد بيماران با عالئم تنفسي در بخش حتي االمكان •

جلوگيري شود ) الاقل با ماسك باشد (به پرسنل بيمار داراي عالئم تنفسي مرخصي اجباري داده •

شود نياز به اطاق با تجهيزات فشار منفي نيست • ساعت ويروس در دماي اطاق زنده ميماند24تا •امكانات ضروري جهت پذيرش بيماران در هنگام اپيدمي ها •

پيش بيني گرددبه بخش هاي بيماران خاص توجه بيشتري مبذول گردد•